Paroxysmal atrial fibrillation (PAF) reduces atrial contractility due to atrial remodeling, but little is known about the process by which contractile function is reconstituted after spontaneous conversion to sinus rhythm (SR). A 63-year-old healthy man developed PAF. PAF persisted for 2 days before spontaneous conversion to SR. Serial echocardiograms were performed at 1, 24 h, 3/4/7 days after conversion. Longitudinal myocardial strain during the pump phase of the left atrium (LA) was generally reduced at 1 h. Normal strain of the LA was restored at 3 days with the exception of the lateral wall, where restoration was delayed until 4 days. The ratio between the mitral early and atrial diastolic velocities (E/A) at 24 h was within a pseudonormal range at 1.8, but the ratio between E and early mitral annulus velocity (e' E/e') remained normal. The E/A ratio gradually decreased until 7 days post conversion, but the E/e' ratio remained normal throughout the observation period. less then Learning objective This case demonstrates that left atrial (LA) contractility was globally suppressed in paroxysmal atrial fibrillation (AF), but showed gradual restoration following conversion to sinus rhythm. Mismatch between the E/A and E/e' were observed until LA contractility was restored. A pseudonormal pattern of the E/A was induced by reduced LA contractility, not left ventricular diastolic dysfunction. The time period over which this reduced LA contractility persists holds the potential to increase paroxysmal AF detection rates.Injury to axillary and subclavian arteries during cardiac rhythm device implantation might lead to significant mortality and morbidity especially in those with a low body mass index (BMI). We report the case of 65-year-old underweight male patient with BMI of 15.1 (height 166 cm, weight 41.8 kg) with long-standing dilated cardiomyopathy who underwent cardiac resynchronization therapy with defibrillator implantation. Left pre pectoral pocket as well as three separate axillary vein accesses were obtained smoothly. While suturing the right ventricular lead sleeve to the underlying muscle a significant amount of arterial bleed was suddenly encountered without a clear source. Traumatic injury to the axillary artery caused by the suture needle was suspected. An immediate angiography of the left axillary artery via femoral approach showed a significant axillary artery side branch leakage adjacent to the sleeve suture site. A covered stent was deployed to the axillary artery which effectively controlled the bleeding immediately. The procedure was then carried out in the usual manner. less then Learning objective Injury to axillary and subclavian arteries during cardiac rhythm device implantation might lead to significant morbidity and mortality with higher incidence in underweight patients. Endovascular covered stenting might be an effective intervention for vascular injuries during cardiac device implantation.A 51-year-old man with normal left ventricular ejection fraction (LVEF) underwent radiofrequency catheter ablation (RFCA) for long-standing persistent atrial fibrillation (AF). After isolating the pulmonary veins (PV), we attempted to ablate multiple non-PV AF triggers evoked by isoproterenol and performed repetitive intracardiac electrical cardioversion under considerable dose of barbiturate. Finally, administration of pilsicainide was required to maintain sinus rhythm. Sixty minutes after the procedure, initiation of development of rapid ST-segment elevation was observed on the continuous electrocardiogram monitor and the patient complained of general fatigue. There was occurrence of complete atrioventricular block and he immediately fell into pulseless electrical activity (PEA). https://www.selleckchem.com/products/ski-ii.html Cardiopulmonary resuscitation was initiated and a percutaneous cardiopulmonary system (PCPS) was provided. Echocardiogram showed severe biventricular systolic dysfunction. Although ST-segment change sustained, emergent coronary angiography was normal. Left ventriculogram showed apical to mid ventricular akinesia and preserved basal contractibility, which was typical of takotsubo syndrome (TS). Fortunately, he recovered completely; the PCPS was weaned on day 5, and the LVEF normalized within 2 weeks without any neurological disorders. This is the first case report of PEA due to TS following AF ablation. TS due to stressors of RFCA procedure should be recognized as a possible life-threatening complication. .The Impella (Abiomed, Danvers, MA, USA) is a novel percutaneous heart pump device for left ventricular (LV) assistance; however, LV thrombus is a notable contraindication for this device. Contrast computed tomography assessment is useful for detecting LV thrombus and preventing thromboembolism in patients recommended for Impella use. .A 66-year-old male had an atrial tachycardia (AT) during a first extensive pulmonary vein (PV) isolation (PVI) of persistent atrial fibrillation. Activation mapping during the AT using Rhythmia (Boston Scientific, Marlborough, MA, USA) exhibited a centrifugal pattern with the earliest activation at the left-sided carina, and conduction towards the inferior left atrium (LA) over the left PVI line. The post-pacing interval was similar to the tachycardia cycle length (TCL) upon entrainment from the LA roof, left-sided carina, and anterior, inferior, and septal LA, but was longer than the TCL upon entrainment from the left superior PV and lateral and posterior LA. These findings suggested the presence of a macroreentrant AT circuit with epicardial conduction from the roof toward the inferior LA via the left-sided carina over the PVI line and propagation to the anterior LA through the septum. A radiofrequency application at the left-sided carina terminated the AT. This case suggested a rare type of PV-gap reentrant AT with multiple epicardial conduction gaps by high-resolution activation mapping and entrainment pacing, which may have been associated with non-transmural radiofrequency lesions along the PVI line. Further, the origin of the residual epicardial gaps may have been subepicardial myocardial strands or the Marshall ligament. .